Privacy Policy

Cornelia Nixon Davis, Inc.
The Davis Community
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN REQUEST ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
Effective February 24, 2003
Rev. 9/9/2010, 9/20/2013, 5/1/2015, 10/15/2016
The Davis Community, which includes Davis Health Care Center, Champions Assisted Living, Davis
Health & Wellness Center at Cambridge Village, and Davis Home Care Services maintains a serious
commitment to ensuring your privacy. We are required to abide by this Notice of Privacy Practices. We
may modify this notice and the revised notice will be effective for all protected health information in our
possession at the time of change and any information created or received after. You may request a copy of
any revised notice by contacting our office. If you have any questions about this notice, please contact our
Quality & Compliance Administrator at 910-686-7195.
Protected Health Information, called PHI, is the demographic, financial, and medical information we collect,
create, and maintain in the course of providing care to you. This notice will inform you how the The Davis
Community may use and disclose protected health information (PHI) in compliance with the Federal Health
Insurance Portability & Accountability Act of 1996 (HIPAA) and Health Information Technology for Economic
and Clinical Health Act (HITECH) as issued in the Omnibus Final Rule.
Uses and Disclosures of Protected Health Information (PHI): We may use and disclose health information
about you for;
• Treatment: We will use and disclose your PHI to provide medical care and assist you in obtaining
physician ordered services, tests, consults, and medications. We will share information with Davis
Community staff, contracting consultants, your physicians, and other health care professionals or their
associates who are directly or indirectly involved in providing treatment or continuity of care to you.
For example, we may communicate information by phone, fax, or computer when scheduling lab tests,
ordering medications, or obtaining physician orders.
• Payment: Your PHI may be used and disclosed for business reasons including, but not limited to,
verifying insurance benefits, obtaining authorization for services, and securing payment for services.
For example, we may telephone your insurance carrier and provide the insurer with demographic
information about you in order to verify eligibility. We provide your insurance with disease and
treatment information in support of billable services. We copy and submit records to agencies
authorized to conduct pre-payment and post-payment clinical reviews.
• Health Care Operations: In the process of operating we may use and disclose your PHI in support of
our operations which include maintaining an in-patient directory, quality assessments, financial or medical
audits, and medical record management. For example, we review protected health information when
conducting chart audits. A consultant Pharmacist reviews medication orders. We maintain the name and
room number of guests and residents in a resident directory for their convenience and may release that
information to visitors or callers unless you request in writing that we exclude your name from the
directory.
Other Uses and Disclosures We May Make Without Your Written Authorization.
We may use and disclose protected health information about you when required by regulation or legally
authorized to do so for;
• Public Health Activities, including reporting of communicable diseases, adverse reactions to
medications, injury from a health care product, and suspected abuse
• Federal and State Agency Oversight, including NC State Surveyors.
• Court Order, Military Order, Subpoena
• Coroners, Medical Examiners, Funeral Directors, Organ Procurement Agencies
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Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization
For uses and disclosures other than for treatment, payment, health care operations, and as required by Law, we
are required to obtain your written authorization. We are required to obtain your written authorization for
marketing purposes and the sale of PHI. If you wish us to release protected health information to individuals or
entities not legally entitled to your records, such as a relative, friend, or attorney you must provide us with
written authorization each time you wish us to release records. The release of psychotherapy notes requires a
separate or stated authorization. You may request the appropriate authorization form from our Medical
Records Department.
Your Rights
You have the following rights with respect to your protected health information, which you can exercise by
presenting a written request to The Davis Community;
• The right to request restrictions on certain uses and disclosures of protected health information,
including those to consultants, family members, or any other person identified by you. We are, however,
not required to agree to a requested restriction. If we do agree, we must abide by it unless you agree in
writing to remove the restriction.
• The right to restrict certain disclosures of PHI to a health plan or insurer when you pay out of pocket in
full for a health care service or item.
• The right to reasonable requests to receive confidential communications of protected health
information from us by alternative means including email or at alternative locations.
• The right to request and receive a paper copy of your records or an electronic copy of records if
maintained in electronic format.
• The right to be notified following a breach of unsecured PHI.
• The right to access protected health information about you that is created by The Davis Community.
The right to request an amendment to protected health information we create. We may deny your
request if it does not contain a reason that supports your request, the information was not created by us,
or we believe the record to be accurate.
• The right to receive an accounting of disclosures of protected health information other than for
treatment, payment, health care operations, or those made pursuant to your written or verbal
authorization or consent.
• The right to opt out or decline to receive any marketing or fund raising material related to the
organization, it’s services, or affiliated services and opportunities.
• The right to obtain a paper copy of this notice from us upon request.
If you have reason to believe that your privacy rights have been violated and/or you wish to file a complaint you
may do so with the Quality & Compliance Administrator or the Department of Health and Human Services Office
of Civil Rights within 180 days from the date of the incident of complaint. Complaints may be filed without fear
of retaliation.
Kathleen Peets US Department of Health & Human Services
Quality & Compliance Administrator Office of Civil Rights
The Davis Community 200 Independence Ave., SW
(910) 686-7195 Washington, DC 20201
(202) 619-0257 (877) 696-6775
I have received a copy of this Notice of Privacy Practices and have been given the opportunity to ask questions
about how protected health information about me is used and my rights regarding that information.
______________________________________ _______________________________________
(print patient name) (patient signature) (date)
______________________________________ _______________________________________
(print authorized rep name) (authorized rep signature) (date)

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General Information Collection

The Davis Community site tracks and collects general information regarding the use of this site. Information such as which pages are visited, the length of time visitors stay on the site, the browsers visitors use, and the times people log on to the site, is collected in aggregate and not applied to specific visitors. Such information may be shared, in aggregate, to help others determine how the site is used and what can be done to make it more helpful to our audience.

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